Cesarean Section

One in three U.S. births is a cesarean — yet many students can't distinguish a planned from an emergent C-section or explain the nursing priorities that change between them.

A cesarean section is surgical delivery through an abdominal and uterine incision. Indications include cephalopelvic disproportion, malpresentation (transverse lie, breech), placenta previa, prior classical uterine incision, failed induction, and non-reassuring fetal status unresponsive to intrauterine resuscitation. Planned (scheduled) cesareans allow preoperative teaching and spinal/epidural anesthesia; emergent cases may require general anesthesia with decision-to-incision goal under 30 minutes. Preoperatively the nurse verifies consent, performs a surgical time-out, inserts a Foley catheter, and ensures IV access with at least an 18-gauge catheter. Postoperatively, priorities are fundal firmness assessment (gently, supporting the incision), lochia monitoring, pain management using a multimodal approach, incentive spirometry and early ambulation within 8–12 hours to prevent DVT and ileus, and monitoring intake/output until the Foley is removed (typically 12–24 hours). The low-transverse uterine incision is most common and carries the lowest risk of rupture in future pregnancies; a classical (vertical) incision is a contraindication to trial of labor due to high rupture risk (4–9%), requiring repeat cesarean for all subsequent deliveries.

Key Distinctions

Don't confuse the skin incision direction with the uterine incision — a vertical skin cut can still have a low-transverse uterine incision, so always check the operative report. Students mix up VBAC eligibility: low-transverse uterine incision may allow trial of labor after cesarean (TOLAC), but a classical uterine incision does not. Emergent C-section nursing priorities differ from planned — verify that general anesthesia aspiration prophylaxis (sodium citrate) is given.

Clinical Pearl

Skin scar ≠ uterine scar. Always read the operative report to know the uterine incision type — it determines every future delivery plan.